Burden of illness of multiple sclerosis: Part I: Cost of illness

Background: Multiple sclerosis (MS) is a common neurologic disease in young and middle-aged adults affecting approximately 35,000 Canadians. The objectives of this study were to estimate the annual and lifetime costs of MS from the Canadian societal perspective. Methods: Patients were consecutively recruited by neurologists in 14 MS outpatient clinics across Canada. They were classified according to the Expanded Disability Status Scale (EDSS) into three groups: mild (EDSS ≤ 2.5), moderate (EDSS = 3.0-6.0) and severe (EDSS ≤ 6.5). Sociodemographic, clinical and resource utilization data were collected retrospectively for the three months prior to patient inclusion. Costing of resources was performed from Ministry of Health, private third party payers, patient and societal perspectives. Average Canadian costs ($CDN 1995) were valued from available provincial data. Results: A total of 198 patients were included in the analysis (mild: n = 62, moderate: n = 68 and severe: n = 68). Costs increased with increasing EDSS scores, from all perspectives. The annualized societal costs per patient were $CDN14,523, $CDN21,698 and $CDN37,024 for the mild, moderate and severe groups, respectively. In all severity groups, most of the financial burden is borne by patients, from 74% to 88%. Indirect costs, namely lost daily activity/leisure time and lost productivity, were the major societal cost drivers. The lifetime cost of MS, including patient institutionalization, was estimated to be $CDN1,608,000 per patient. Conclusions: In Canada, MS is associated with enormous direct and indirect costs. Patients carry most of the economic burden of this disease. The results of this burden of illness study provide a basis for cost-effectiveness analyses of new therapeutic interventions for MS.